Researchers at the University of Alberta have found that a portable blood test used by athletes to measure lactic acid levels can quickly identify even children seriously ill with malaria.
This study is a secondary analysis of clinical trials previously conducted by Michael Hawkes. He is an Associate Professor in the Department of Pediatrics. Additionally, he is a distinguished researcher at the former Stollery Science Lab at the Stollery Children’s Hospital Foundation.
Hawkes did not design the initial clinical trials to investigate the function of the device measuring lactic acid. However, it was the secondary analysis conducted by KT Mitran that yielded important insights. Mitran has a PhD in public health and is a third-year medical student at the U of A.
According to a study authored by Mitran, children with malaria have a higher risk of hospitalization and mortality due to high lactic acid levels.
Cells produce lactic acid by breaking down glucose and carbohydrates to generate energy for body processes. This happens when cells need more oxygen than normal, such as during intense exercise.
“Lactic acid is a known marker of severe disease in a lot of (malaria) cases,” Mitran said.
According to the World Health Organization, parasite-infected mosquitoes spread malaria, a deadly blood-borne disease. Infants, pregnant women, children under five years of age, and individuals with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) are at higher risk of infection.
“Malaria killed 619,000 people (worldwide) in 2021 and the majority of them are children under five years of age in sub-Saharan Africa,” Mitran said.
Mitran says cells produce lactic acid due to lack of oxygen during illness.
During illness, cells produce excess lactic acid when they are not getting enough oxygen from the blood.
“Lactic acid build-up is dangerous because it means the body is not getting enough oxygen,” Mitron said. “Cells, which make up the body’s tissues and organs, attempt to adapt and compensate for the lack of oxygen by producing more lactic acid than normal.”
Cells and tissues need lots of oxygen for metabolism to create energy. When oxygen needs are not met, cells will compensate. They alter the metabolic process and produce lactic acid as a by-product.
The measuring device is similar to the blood glucose monitoring devices used by individuals with type 2 diabetes. Only a small amount of blood from a finger prick is required to quickly determine lactic acid levels.
“With malaria, there are many different reasons for having high levels of (lactic acid in the blood),” Mitran said. “If you get severe anemia because of the parasites, which is a very common thing in malaria, all of (your) tissues can be deprived of oxygen.”
The parasite can also damage lung tissue, preventing oxygen from entering the bloodstream, Mitran said.
According to Mitran, “parasites can cause blockage of small blood vessels,” depriving nearby cells of oxygen. Some parasites, which produce lactic acid, can live in red blood cells, which carry oxygen to tissues and organs. The parasite also affects the functioning of the liver and kidneys, which clear lactic acid from the bloodstream. Due to damage to these organs, the level of lactic acid in the blood becomes higher than normal.
“Not only do you have increased lactic acid production, but you also have decreased lactic acid clearance,” Mitron said. “His balance can be completely different in each patient. “They’re still trying to figure out malaria.”
“This is potentially a useful tool to add to the evaluation of these patients,” says Mitran.
Mitran said one advantage of the device is its stability. The location or degree of expertise of the person using the device does not affect effectiveness.
“We used this tool to show whether it’s a highly trained physician in a large referral hospital in Uganda or it’s a community health care worker in a rural setting. Somehow, the device performed the same,” Mithran said.
According to Mitran, the usefulness of lactate level testing lies in the tool’s ability “(in)to predict mortality in these children as well as in clinical assessment.”
“When you add those two factors together, it can more accurately predict death. So, this showed that this is potentially a useful tool to add to the assessment of these patients.”
The team plans to see whether using the tool to quickly identify children at high risk of mortality will have a positive impact on patient health outcomes.